Hyperuricemia and Acute Renal Failure in Renal Transplant Recipients Treated With High-Dose Mizoribine

BACKGROUND

Hyperuricemia is a common adverse event frequently found in renal transplant recipients with mizoribine (MZ). Hyperuricemia itself will be a cause of renal dysfunction, and renal dysfunction also will be a cause of hyperuricemia simultaneously. This study investigates frequency of hyperuricemia and renal failure in renal transplant recipients treated with high-dose MZ.

PATIENTS AND METHODS

From December 2007 to October 2015, there was a total of 32 living related renal transplant recipients treated with high-dose MZ. Of the 32 patients, 28 were treated with urate-lowering medications.

RESULTS

One patient received allopurinol (AP) and 13 patients received benzbromarone (BB). For 6 of them, their urate-lowering medications were converted to febuxostat (FX) form AP or BB. In the remaining 14 patients, FX was administered from the beginning. In 2 cases of ABO-incompatible living related renal transplant recipients who were maintained with high-dose MZ and BB, severe hyperuricemia and acute renal failure occurred. One patient was a 48-year-old man, and his creatinine (Cr) level increased to 8.14 mg/dL and his serum uric acid (UA) was 24.6 mg/dL. Another patient was a 57-year-old man, and his Cr level increased to 3.59 mg/dL and his UA was 13.2 mg/dL. In both cases Cr and UA were improved, and no finding of acute rejection and drug toxicity was observed in graft biopsy specimens. BB was switched to FX and discontinuance or reduction of MZ was done.

CONCLUSION

Combination of MZ and BB has the risk of acute renal dysfunction after renal transplantation. Latent renal dysfunction should be watched for in renal transplant recipients receiving high-dose MZ.

Myeloperoxidase in blood neutrophils during normal and abnormal menstrual cycles in women of reproductive age

INTRODUCTION

We previously reported that granulocyte colony-stimulating factor (G-CSF) plays a critical role in ovulation, suggesting that neutrophils may maintain ovulation. We assessed myeloperoxidase (MPO), a major and specific enzyme of neutrophils, in women with abnormal and normal menstrual cycles to clarify the relationship between MPO and ovulation.

METHODS

We analyzed MPO activity in blood neutrophils of women with abnormal menstrual cycles (indicative of anovulation, n = 12) and age- and body mass index-matched normal menstrual cycles (indicative of ovulation, n = 24) using two parameters as a marker of MPO, Neut X and mean peroxidase index (MPXI).

RESULTS

MPO of women with abnormal menstrual cycles was significantly lower than that of women with normal menstrual cycles [Neut X: 62.6 ± 1.1 (mean ± standard error of the mean) vs. 66.2 ± 0.3, P = 0.009; MPXI: -0.54 ± 1.66 vs. 4.91 ± 0.53, P = 0.008]. Among women with normal menstrual cycles, MPO was highest in the follicular phase (Neut X: 67.0 ± 0.3; P = 0.033).

CONCLUSION

The difference in MPO between women with abnormal and normal menstrual cycles and the upregulation of MPO before ovulation suggest that neutrophils and MPO are closely related to ovulation.

Development of low-temperature desulfurization performance of a MnO2/AC composite for a combined SO2 trap for diesel exhaust

MnO₂/AC composite was proposed as a low temperature desulfurization material for a combined SO₂ trap.

Progress in the treatment of unruptured aneurysms

Recent technological progress has reduced the complication rate of unruptured aneurysm. We treated 128 unruptured aneurysms between April 2006 and March 2012. Seventy-six aneurysms (59 %) were clipped and 52 (41 %) were coil embolized. After 2010, we applied new instruments, i.e., near-infrared indocyanine-green videoangiography (ICG), an intraoperative endoscope, preoperative detailed MRI, and a stent-assisted coil embolization. In the results: (1) In 60 aneurysms treated before 2009, three patients showed a deterioration of more than two points in mRS (5 %). In 68 aneurysms treated after 2010, no patients showed deterioration (0 %) (p: n.s.). (2) No patients died and 126 patients (98 %) were discharged to home directly. (3) No patients showed rupture after treatment. In conclusion, the appropriate selection of treatment and recent technological progress have facilitated sophisticated treatment of unruptured aneurysms. Recently, the complication rate in surgery and endovascular surgery for unruptured aneurysms has become acceptably low.

Trigonal cavernous malformation with intraventricular hemorrhage: a case report and literature review

We reported a case of trigonal cavernous malformation (CM) with intraventricular hemorrhage. This 67-year-old woman experienced sudden onset of loss of consciousness and her Glasgow Coma Scale (GCS) was 5 points (E1V1M3) on admission. CT scan demonstrated intraventricular hemorrhage and acute hydrocephalus. Angiography did not demonstrate any vascular abnormality. Ventricular drainage was performed for acute hydrocephalus and the postoperative course was good. CT showed a hyperdense lesion in the left trigone, which was contrast-enhanced on T1-weighted MR. Removal of CM was performed via the left middle temporal sulcus. We conducted a Pub Med search for trigonal CM and found 17 cases. Herein we discuss the symptoms, CT and MR findings and treatment.

[Two cases of spontaneous intracranial hypotension with bilateral chronic subdural hematomas]

Spontaneous intracranial hypotension (SIH) is characterized by postural headaches without obvious cause and is occasionally related to chronic subdural hematomas (CSHs). Brain sag due to decrease in cerebrospinal fluid, and growing CSHs may occur secondary to a decrease in intracranial pressure. Therapy for this condition differs from that for mere traumatic CSHs and is controversial. We report 2 cases of CSH related to SIH. One patient required drainage of the CSHs and an epidural self-blood patch. Furthermore, this patient had to undergo reoperation for drainage of the CSHs. The other patient was cured after the first time the CSHs were drained.

Effects and complications of stereotactic aspiration for spontaneous intracerebral hemorrhage

Stereotactic aspiration of intracerebral hemorrhage (ICH) improves the general condition of patients, promotes improvement of consciousness, and decreases the incidence of pneumonia, but may induce rebleeding. The present study investigated the effects of stereotactic aspiration and factors that inhibit rebleeding in 70 consecutive patients who underwent stereotactic aspiration for ICH. Consciousness was significantly improved after surgery. Of patients who underwent surgery on day 0 or 1, 5 patients developed pneumonia and 29 patients did not. Of patients who underwent surgery on day 2 or later, 14 patients developed pneumonia and 22 patients did not. Early surgery within 2 days significantly reduced the rate of aspiration pneumonia. Patients with rebleeding tended to have liver dysfunction and hemorrhagic tendency. Early stereotactic aspiration of ICH facilitates better patient management than conservative treatment in patients with moderate consciousness disturbance. Patients with liver dysfunction and hemorrhagic tendency should be identified.

Detection of necrotic neural response in super-acute cerebral ischemia using activity-induced manganese-enhanced (AIM) MRI

Immediate and certain determination of the treatable area is important for choosing risky treatments such as thrombolysis for brain ischemia, especially in the super-acute phase. Although it has been suggested that the mismatch between regions displaying 'large abnormal perfusion' and 'small abnormal diffusion' indicates a treatable area on an MRI, it has also been reported that the mismatch region is an imperfect approximation of the treatable region named the 'penumbra'. Manganese accumulation reflecting calcium influx into cells was reported previously in a middle cerebral artery occlusion (MCAO) model using activity-induced manganese-enhanced (AIM) MRI. However, in the super-acute phase, there have been no reports about mismatches between areas showing changes to the apparent diffusion coefficient (ADC) and regions that are enhanced in AIM MRI. It is expected that the AIM signal can be enhanced immediately after cerebral ischemia in the necrotic core region due to calcium influx. In this study, a remote embolic rat model, created using titanium-oxide macrospheres, was used to observe necrotic neural responses in the super-acute phase after ischemia. In addition, images were evaluated by comparison between ADC, AIM MRI, and histology. The signal enhancement in AIM MRI was detected at 2 min after the cerebral infarction using a remote embolic method. The enhanced area on the AIM MRI was significantly smaller than that on the ADC map. The tissue degeneration highlighted by histological analysis corresponded more closely to the enhanced area on the AIM MRI than that on the ADC map. Thus, the manganese-enhanced region in brain ischemia might indicate 'necrotic' irreversible tissue that underwent calcium influx.

[Rapidly growing progressive massive fibrosis that was difficult to differentiate from lung cancer: report of a case]

The subject was a 79-year-old male. When he was 50-years-old, he was diagnosed to have pneumoconiosis, and his clinical course was monitored periodically during his stay at our hospital. In October 2007, chest computed tomography (CT) revealed a new shadow of a tumor mass in the right lower lobe. Lung cancer could not be ruled out by either CT or fluorodeoxyglucose-positron emission tomography (FDG-PET), and a definite diagnosis could not be established. Therefore, to make a diagnosis, we performed a partial resection of the lung and a diagnosed of progressive massive fibrosis (PMF) was obtained pathologically. Patients with pneumoconiosis have a possibility of developing new manifestations of PMF as a rapidly growing mass like a case presented in this report

Combination chemotherapy with docetaxel and nedaplatin for recurrent esophageal cancer in an outpatient setting

The purpose of this study was to address the feasibility of combination chemotherapy of docetaxel and nedaplatin for recurrent esophageal cancer patients in an outpatient setting. Patients received docetaxel (30 mg/m(2) intravenously) on day 1 and nedaplatin (40 mg/m(2) intravenously) on day 1 every 2 weeks. In total, 28 patients with recurrent esophageal cancer after the initial treatment (esophagectomy, chemotherapy and/or chemoradiotherapy) were enrolled. Each patient received six cycles of treatment and was evaluated with a computed tomography scan. The percentage of patients who completed this therapy was 60.7%. Complete response and partial response were achieved by 3.6% and 35.7% of patients, respectively. The most frequent toxicities were leukopenia and anemia; non-hematological toxicities were generally mild. There was no treatment-related death. The median survival time and 1-year survival rate were 8.5 months and 15.9%, respectively. This outpatient combination chemotherapy was useful as second-line chemotherapy for recurrent esophageal cancer.

Cell cycle-regulated factors in esophageal cancer

Alterations of cell cycle-regulated genes play an important role in the process of carcinogenesis, and some of them are thought to be prognostic factors in esophageal cancer. The expressions of p53, p16, pRB and Cyclin D1 proteins were evaluated immunohistochemically in 144 patients who underwent curative esophagectomy without any adjuvant therapy before surgery. p53 overexpression was observed in 99 (69%) out of the 144 patients. No significant correlation was noted between p53 and any other gene expression. p16 expression was observed in 12 (8.3%) out of all cases. A negative correlation was recognized between p16 and Cyclin D1 expression (P=0.0004). pRB expression was observed in 130 (90.3%) out of all cases, whereas pRB expression was not observed in 11 out of the 12 patients with p16-positive tumors. A negative correlation was also found between p16 and pRB (P < 0.0001). A positive correlation was noted between pRB and Cyclin D1 expression (P=0.0009). The cumulative survival rate of patients without pRB expression was significantly lower than that of patients with positive expression (P=0.003). In the multivariate survival analysis, pRB expression was an independent prognostic factor. In 98% of all patients with esophageal cancer, impairment of the G1 checkpoint is due to a loss of function by p16, pRB or Cyclin D1, which showed a negative correlation in each factor. In addition, aberrant expression of pRB is useful as a prognostic factor in esophageal cancer.

Comparative study of self-expandable metallic stent and bypass surgery for inoperable esophageal cancer

We evaluated the effect of two different therapies for 23 patients with inoperable esophageal cancer, of whom 13 patients underwent placement of a metallic stent and 10 received bypass surgery. We newly defined the improved level of food intake and the effective rate based on the grade of the patient's status in order to evaluate objectively. Although the effect of stent placement was significantly better than that of bypass surgery, there were no significant differences in the improved level of food intake and the effective rate between the two groups. Four out of 10 patients in the bypass group had suture insufficiency, resulting in no oral intake and a fatal outcome. In addition, the ratio of survival period of ability to ingest orally and in-hospital mortality was significantly favorable in the stent group compared with the bypass group. In conclusion, stent placement should be the first choice for inoperable malignant stenosis or esophageal fistula.

Comparison of plastic prostheses and self-expandable metallic stents in the treatment of malignant esophageal stenosis

OBJECTIVE

We compared the efficacy of plastic prostheses and self-expandable metallic stents in the treatment of malignant esophageal stenosis and/or fistula.

SUBJECTS AND METHODS

Subjects were 31 patients with esophageal cancer, 4 with esophagotracheal fistula, and 1 with esophageal stenosis. A plastic prosthesis was inserted in 15 patients (group A) and a self-expandable metallic stent in 21 patients (group B). We evaluated food ingestion improvement, effectiveness, complications, mean survival, food ingestion duration, the percentage of food ingestion capability in total survival time, and inhospital mortality.

RESULTS

No differences were seen in food intake improvement or in the effectiveness between groups, whereas fatal complications were higher in Group A. No significant differences were seen in mean survival, food ingestion duration, percentage of food ingestion capability, or inhospital mortality between groups.

CONCLUSION

We concluded that a self-expandable metallic stent was safer than a plastic prosthesis because of fewer serious complications such as bleeding, and recommended the use of metallic stents in the treatment of malignant esophageal stenosis and/or fistula.

The influence of sex hormones on renal osteopontin expression and urinary constituents in experimental urolithiasis

PURPOSE

To our knowledge the influence of sex hormones on urinary stone formation remains undetermined. We investigated the effect of castration on urinary lithogenic factors and renal osteopontin expression in rats previously treated with ethylene glycol.

MATERIALS AND METHODS

Sprague-Dawley rats were divided normal males, castrated males, males with 2 weeks of 0.75% ethylene glycol treatment, castrated males with 2 weeks of 0.75% ethylene glycol treatment, normal females, castrated females, females with 2 weeks of 0.75% ethylene glycol treatment and castrated females with 2 weeks of 0.75% ethylene glycol treatment. We analyzed 24-hour urine samples for urinary constituents, such as calcium, oxalate, citrate, uric acid, phosphate, magnesium, sodium, potassium and creatinine. The kidneys were examined for osteopontin expression by Northern blot analysis and for crystal deposition by histological examination.

RESULTS

In intact male rats calcium and citrate excretion decreased and oxalate excretion increased significantly after ethylene glycol treatment. Castrated male rats with ethylene glycol had greater calcium and less oxalate excretion than male intact rats with ethylene glycol. In intact female rats uric acid excretion decreased and only calcium excretion increased significantly after ethylene glycol treatment. Castrated female rats with ethylene glycol excreted significantly more oxalate and less calcium than intact female rats with ethylene glycol. Renal osteopontin expression was the same in male intact and castrated rats, and in female intact and castrated rats. In males with ethylene glycol expression was stronger in castrated than in intact rats. In females with ethylene glycol expression was weaker in castrated than in intact rats. No crystal deposits were found in the kidneys in any group.

CONCLUSIONS

Testosterone appears to promote stone formation by suppressing osteopontin expression in the kidneys and increasing urinary oxalate excretion. Estrogen appears to inhibit stone formation by increasing osteopontin expression in the kidneys and decreasing urinary oxalate excretion.

Right internal jugular vein venography in infants and children

We obtained venograms of the right internal jugular vein (RIJV) in 105 infants and children with congenital heart disease during cardiac catheterization. No major anomalies were found in the course of the RIJV. The diameter of the RIJV tended to increase with the patient's age, weight, and height. However, some disproportionately small vessels were seen in 8% of the patients. The depth from the skin to the RIJV varied from 2.5 to 20 mm and did not significantly correlate with age, weight, or height. Confirmation of the diameter or the depth of the RIJV by venography may facilitate clinical decisions and may be useful for performing percutaneous cannulation.

IMPLICATIONS

We obtained venograms of the right internal jugular vein in children with congenital heart disease. Generally, the diameter increased with the patient's body size, but disproportionately small vessels were seen in 8% of the patients. Preoperative internal jugular venography may facilitate identifying those patients.

[Three cases of pituitary abscess]

We report three cases of pituitary abscess. Three patients, all females, had suffered headache and complained of general fatigue. In each case magnetic resonance imaging (MRI) revealed a sellar mass with suprasellar extension. T1-weighted images revealed an isointense or slightly hypointense lesion with thin ring-enhancement following gadolinium injection. No inflammatory signs were found in two cases. In one case, a gradual change in clinical symptoms and MRI findings was noted: the hypophyseal hemorrhagic lesion detected on MRI changed into a cystic lesion with thin ring-enhancement. Transsphenoidal surgery was performed in all three cases. In each case, however, no organism was cultured and no tumor component was found. It is difficult to diagnose pituitary abscess prior to surgery if no inflammatory signs are present. Diagnosis of this condition requires careful radiological evaluation. Findings of a suprasellar round cystic mass with thin ring-enhancement on MRI associated with thickened stalk, hyperprolactinemia, and diabetes insipidus may be suggestive of a pituitary abscess.

High linear energy transfer carbon radiation effectively kills cultured glioma cells with either mutant or wild-type p53

PURPOSE

A mutation in the p53 gene is believed to play an important role in the radioresistance of many cancer cell lines. We studied cytotoxic effects of high linear energy transfer (LET) carbon beams on glioma cell lines with either mutant or wild-type p53.

METHODS AND MATERIALS

Cell lines U-87 and U-138 expressing wild-type p53 and U-251 and U-373 expressing mutant p53 were used. These cells were irradiated with 290 MeV/u carbon beams generated by the Heavy Ion Medical Accelerator in the National Institute of Radiologic Science or X-rays. A standard colony-forming assay and flow cytometric detection of apoptosis were performed. Cell cycle progression and the expression of p53, p21, and bax proteins were examined.

RESULTS

High LET carbon radiation was more cytotoxic than low LET X-ray treatment against glioma cells. The effects of the carbon beams were not dependent on the p53 gene status but were reduced by G(1) arrest, which was independent of p21 expression. The expression of bax remained unchanged in all four cell lines.

CONCLUSION

These results indicate that high LET charged particle radiation can induce cell death in glioma cells more effectively than X-rays and that cell death other than p53-dependent apoptosis may participate in the cytotoxicity of heavy charged particles. Thus, it might prove to be an effective alternative radiotherapy for patients with gliomas harboring mutated p53 gene.

Cariostatic activity of cacao mass extract

Chocolate is suspected to contain some caries-inhibitory substances. The cariostatic activity of cacao mass extract (CM), the main component of chocolate, was examined in vitro and in experimental animals. CM showed no detectable effects on the cellular growth and acid production of mutans streptococci. On the other hand, the cell-surface hydrophobicity of mutans streptococci was significantly reduced by the presence of CM. Furthermore, insoluble glucan synthesis by the glucosyltransferases from either Streptococcus mutans MT8148R or Strep. sobrinus 6715 was inhibited by CM, but not significantly. Hence, the sucrose-dependent cell adherence of mutans streptococci was also depressed by CM. Finally, CM in both a 40% sucrose diet and drinking water resulted in reductions of caries development and plaque accumulation in rats infected with Strep. sobrinus 6715, but not significantly. These results indicate that cacao mass extract possesses some anticariogenic potential, but its anticaries activity is not strong enough to suppress significantly the cariogenic activity of sucrose.

Caries inhibitory activity of cacao bean husk extract in in-vitro and animal experiments

Cacao bean husk extract (CBH) was examined for inhibitory effects on the caries-inducing properties of mutans streptococci in vitro and on caries development in specific pathogen-free Sprague-Dawley rats infected with mutans streptococci. CBH reduced the growth rate of almost all oral streptococci examined, which resulted in the reduction of acid production. Furthermore, insoluble glucan synthesis by the glucosyltransferases from Streptococcus mutans MT8148R and Streptococcus sobrinus 6715 was significantly inhibited by CBH. Hence, the sucrose-dependent cell adherence of mutans streptococci was also depressed by CBH. The administration of CBH in drinking water resulted in significant reductions of caries development and dental plaque accumulation in rats infected with either Strep. sobrinus 6715 or Strep. mutans MT8148R, and the minimum cariostatic concentration was 1.0 mg/ml. These results indicate that CBH possesses powerful anticariogenic potential.

Long-term follow-up study of unruptured vertebral artery dissection: clinical outcomes and serial angiographic findings

OBJECT

Although the spontaneous occurrence of an unruptured vertebral artery (VA) dissection has increasingly been recognized as a relatively common cause of stroke, and the clinical aspects of this lesion have gradually been determined, its natural course remains obscure. The main goal of this study was to clarify the management protocol for this condition by examining serial angiographic changes in patients with unruptured VA dissections.

METHODS

Seventeen patients with unruptured VA dissections, including 13 men and four women, were clinically and angiographically examined between 1993 and 1998. All patients were observed using serial angiography studies. The initial angiography examinations most frequently revealed stenotic lesions (appearance of a pearl-and-string sign or string sign) in eight (47.1%) of 17 cases. In 15 cases (88.2%), changes in the lesions were evident on follow-up angiography studies. Stenotic lesions resulted in occlusion in four cases, normalization in three, and subsequent formation of an aneurysm in one case, which was treated successfully by proximal occlusion of the affected vessel performed using a detachable balloon. Occluded lesions, which were initially observed in three patients, recanalized in two patients and remained unchanged in one patient. Fusiform dilation alone was demonstrated in three patients during the initial angiography session; these lesions became normalized or were unchanged on follow-up studies. Saccular aneurysms were observed in two patients. In one of these cases, proximal ligation of the parent artery was successfully performed because of subsequent aneurysm enlargement. A double lumen, which appeared in one patient with an extradural VA dissection, became occluded. Magnetic resonance T2-weighted imaging studies revealed infarction corresponding to the posterior circulation in seven cases. During long-term observation in this series, good or excellent recovery was obtained in 14 (87.5%) of 16 patients, and moderate or severe disability in two (12.5%); one patient was lost to follow up after the second angiography study.

CONCLUSIONS

A follow-up angiography study must be performed during the early stage (within approximately 3 weeks after onset of symptoms) to confirm the formation or enlargement of an aneurysm, because such conditions may be amenable to surgical treatment. Unruptured VA dissection could otherwise be treated and followed conservatively. Although the majority of dissected lesions seem likely to stabilize within a few months, as evidenced on angiography, in some cases a longer observation period is required.

[A resected case of large cell neuroendocrine carcinoma]

Large cell neuroendocrine carcinoma (LCNEC) is a rare lung cancer and it has a poor prognosis. We describe our experience with a patient in whom LCNEC was diagnosed. 38-year-old woman who complained of a cough and low grade fever up was admitted to our hospital. Chest X-ray and CT shoued 6.5 x 5.0 mass in rt-S1 and S2. It was suspected as LCNEC of the right lung because of broncopscopic cytology. The upper lobectomy of the right lung and desection of mediastinal lymph nodes were performed. Pathological diagnosis was III B (T2N2M0) LCNEC. Four weeks after the operation, one cycle of chemotherapy (CDDP + VP - 16 + VDS) and one cycle of chemoradiotherapy (thoracic radiation of 40 Gy, CDDP + 5 - FU) were performed. There are no findings of tumor recurrence 7 months after operation.

Metachronous triple cancers of the sigmoid colon, stomach, and esophagus: report of a case

We report herein an unusual case of metachronous triple cancers of the sigmoid colon, stomach, and esophagus. A 60-year-old man was initially admitted to our hospital for investigation of occult fecal blood. This was found to be caused by sigmoid colon cancer which was resected in July 1985 (T3, N0, M0; Stage II). A follow-up endoscopy performed in 1990 showed early gastric cancer, and a gastrectomy was performed in August 1990 (Tis, N0, M0; Stage 0). Another endoscopic examination performed as follow-up in 1993 revealed early cancer of the remnant stomach, and all the remnant stomach was surgically resected in March 1993 (Tis, N0, M0; Stage 0). He presented again in December 1996, complaining of discomfort in the chest which was found to be caused by cancer of the middle thoracic esophagus. Although surgery was considered necessary, the patient refused to undergo any further operations. Instead, radiation was administered from January 1997. An endoscopy after the completion of radiotherapy confirmed that the cancer had almost disappeared; however, it started to grow again from the beginning of 1998. He was hospitalized due to esophageal stenosis in April 1998, and died of carcinomatous cachexia in September of the same year.

Systemic inflammatory response syndrome and acute renal failure associated with Hemophilus influenzae septic meningitis

Sepsis is often associated with a downward spiral through a spectrum of systemic inflammatory response syndrome (SIRS) culminating in organ failure and death. Here we present a 3-year-old girl with Hemophilus influenzae septic meningitis who developed SIRS and acute renal failure. In the initial stage, the patient showed uremia, cytopenia, disseminated intravascular coagulation, elevation of tissue enzyme and ferritin values, hemophagocytosis and overproduction of nitric oxide. The serum cytokine profile revealed increased levels of soluble interleukin (IL)-2 receptor, IL-6, IL-10 and tumor necrosis factor alpha. The patient responded positively to early and intensive interventions including antibiotics, repeated exchange transfusions, dexamethasone and high-dose gamma-globulin. The above laboratory abnormalities almost normalized with clinical improvement. We consider that SIRS was probably responsible for the sequence of events resulting in renal failure in this case, and suggest that renal failure should be included among the serious complications of SIRS associated with Hemophilus influenzae septic meningitis.

A horizontal CT system dedicated to heavy-ion beam treatment

A horizontal helical CT system to be used for 3-D treatment planning and for positioning verification of patients in seated position was installed in the treatment room with a fixed horizontal heavy-ion beam line. The system achieved the expected mechanical consistency and reliability.

Effect of an atypical adrenergic beta3-agonist, GS-332: sodium (2R)-[3-[3-[2-(3-chlorophenyl)-2-hydroxyethylamino]cyclohexyl]phenoxy] acetate, on urinary bladder function in rats

We have developed an atypical adrenergic beta3-agonist, GS 332: Sodium (2R)-[3-[3-[2-(3 Chlorophenyl)-2-hydroxyethylamino]cyclohexyl]phenoxy]acetate, which has an unique structure compared to other beta3 agonists. In vitro study, we compared effects of GS 332 on rat urinary bladder muscle strip contractility with those of clenbuterol hydrochloride (clenbuterol), an adrenergic beta2 agonist. GS-332 relaxed isolated rat urinary bladder strips in a concentration dependent manner with 50% effective concentration (EC50) of 15.7 nM, and the relaxant activity of GS 332 was as potent as that of clenbuterol(EC50; 30.8 nM). The concentration response curve of GS 332 on isolated rat urinary bladder was competed by a specific beta3-antagonist, SR59230A in a concentration-dependent manner, in which Schild slope was 1.1 and pA2 value of SR59230A was 7.1. In vivo study, cystometory investigated in anesthetized rats demonstrated that GS 332 was more potent in increasing the urinary storage volume than clenbuterol and less potent in inhibiting the contractile force of urinary bladder at micturition reflex than clenbuterol. These data demonstrate that GS 332, a new adrenergic beta3-agonist, may be more useful to maintain continence than clenbuterol, an adrenergic beta3 adrenergic agonist.

Isolation and characterization of an invertase and its repressor genes from Schizosaccharomyces pombe

PCR was used to isolate an invertase homolog gene from the fission yeast Schizosaccharomyces pombe. The cloned inv1(+) gene encodes a protein of 581 amino acids with 16 potential asparagine-linked glycosylation sites, and has 39% and 38% identity to the Schwanniomyces occidentalis and Saccharomyces cerevisiae SUC2 invertases. When the inv1(+) gene was disrupted, S. pombe strains lacked detectable invertase activity. This result showed that the inv1(+) gene encodes only one active invertase in S. pombe cells. The transcription of inv1(+) is repressed in the presence of glucose. The transcription of inv1(+) was not affected in cyr1Delta strain which lacks adenylate cyclase activity, unlike transcription of S. pombe fbp1(+) gene. We have identified an S. pombe gene (scr1(+)) that encodes a homolog of the Aspergillus nidulans CREA which is required for glucose repression of the glyconeogenic pathway. Although the deletion of scr1(+) did not influence the transcription of fbp1(+) gene, glucose repression of the inv1(+) gene was severely affected. These results showed that glucose repression of inv1(+) gene is dependent on scr1(+) gene, and S. pombe cAMP signalling pathway may not be essential for glucose repression of inv1(+) gene.

[Influence of methylprednisolone and transforming growth factor-beta on wound healing]

This study was aimed at evaluating the influence of transforming growth factor-beta (TGF-beta) on methylprednisolone induced inhibition of wound healing. C57BL/6 mice underwent a standardized dorsal incision. At regular intervals after wounding the mice were sacrificed and their pelts were excised. The fresh breaking strength (FBS) of the pelts was then measured with a constant-speed tension meter. 1) In the first experiment, designed to determine if methylprednisolone did in fact have any inhibiting effect on wound healing, mice received methylprednisolone and a control group received saline. Both methylprednisolone and saline were administered for a four day period. In this experiment the FBS of methylprednisolone treated mice was weaker than that of the control group on the 14th and the 21st day. 2) In the second experiment, designed to determine when the administration of methylprednisolone most noticeably inhibited wound healing, mice were divided into three groups which received methylprednisolone in the following manner: for three days prior to wounding, on the day of wounding, and for three days immediately following wounding. The fourth group received no methylprednisolone at all. The FBS of mice treated with methylprednisolone for three days prior to wounding was weaker than that of the control group on the 14th day after wounding, but showed no significant difference on the 21st day after wounding. The FBS of mice treated on the operative day was weaker on both the 14th and the 21st day after wounding. The FBS of mice treated three days after wounding showed no significant difference on the 14th day after wounding, but was weaker than the control group on the 21st day after wounding. 3) In the third experiment, designed to determine at what time the administration of TGF-beta most accelerated wound healing, mice were divided into three groups which received TGF-beta at different intervals. The first group received TGF-beta on the day of wounding, the second group received TGF-beta on the third day after wounding, and the third group received TGF-beta on the 7th day after wounding. A control group received no treatment. In this experiment the FBS of mice treated with TGF-beta on the third day after wounding was stronger than that of the control group when measured on the 7th and 11th day after wounding, but there was no significant difference on the 14th day. The FBS of mice treated on the day of wounding and mice treated on the 7th day after wounding was not significantly different from that of the control group. 4) In the fourth experiment, designed to determine if TGF-beta can prevent methylprednisolone-induced inhibition of wound healing, mice were divided into three groups. The first group received methylprednisolone for four days prior to wounding. On the third day after wounding they were given saline. The second group also received methylprednisolone for four days prior to wounding, but was treated with TGF-beta on the third day after wounding. The third group received no methylprednisolone, and was given saline three days after wounding. In this experiment the FBS of mice which received only methylprednisolone and saline was weaker than that of the control group on both the 14th and the 21st day after wounding. However, there was no significant difference between the FBS of methylprednisolone treated mice which received TGF-beta and the control group on both the 14th and the 21st day after wounding. From these results the following conclusions were drawn: 1) Methylprednisolone does inhibit wound healing. 2) The influence of methylprednisolone on wound healing is stronger if it is received on operative day. 3) TGF-beta can accelerate wound healing. 4) TGF-beta can prevent methylprednisolone induced inhibition of wound healing.

Detection of HIV-1 and HIV-2 antibodies among Chlamydia trachomatis infected pregnant women in Japan

An anonymous unlinked HIV antibody test was conducted on 1632 Chlamydia trachomatis (C. trachomatis) antibody positive women from 10 institutes of 7 prefectures in Japan. All the sera were negative for both HIV-1 and HIV-2 antibodies. The result may support the suggestion that HIV prevalence is low among general population in Japan. Such a test as this study will be useful not only for developing a reliable HIV surveillance system but also for the study of sexual behavior of general population, since C. trachomatis infection is sensitive to reflect sexual contact.

["Disproportionately large, communicating fourth ventricle" due to membranous obstruction of Magendie's foramen]

A case of disproportionately large, communicating fourth ventricle (DLCFV) with the entire ventricular system dilated symmetrically due to membranous obstruction of Magendie's foramen is reported. A 20-year-old female complained of headache and nausea. Slight papilledema was found in both eyes. CT scan and MRI showed that the entire ventricular system was dilated symmetrically, but we could not locate the cause of this disease, for example, tumor, arachnoid cyst, cerebellar malformation and so on. Although cinemode-MRI showed CSF pulsation as if CSF flowed through Magendie's foramen, we were not convinced that CSF flowed through it. We speculated that something obstructed CSF flow at Magendie's or Luschka's foramen, so surgery was performed by suboccipital craniectomy. As expected, a membranous obstruction was found at Magendie's foramen. After excision of the membrane, all symptoms improved. Postoperative cinemode-MRI clearly demonstrated CSF flow through Magendie's foramen. Ventriculoperitoneal shunting is generally effective for DLCFV, but we do not consider it the optimal treatment. The cause of DLCFV must be confirmed by suboccipital craniectomy if evidence of NPH, mass lesion or cerebellar malformation cannot be found anywhere especially around Magendie's foramen.

Detection of donor lymphocytes in the cerebrospinal fluid of a patient with metachromatic leukodystrophy following bone marrow transplantation

An unrelated donor bone marrow transplant (UD-BMT) was carried out on a 10-year-old patient with metachromatic leukodystrophy (MLD). We collected cerebrospinal fluid (CSF) on day +168 and cultured it with recombinant IL-2 and PHA-P to examine the origin of cells in the CSF. Analysis on variable number of tandem repeat (VNTR) of lymphocytes in the CSF amplified by PCR revealed that lymphocytes in the CSF were of donor origin. These data support that BMT at an early stage may prevent deterioration in MLD. Although the patient developed grade III acute GVHD with rash and diarrhea, we successfully treated acute GVHD using rabbit anti-human thymocyte immunoglobulin (ATG). UD-BMT may be an alternative treatment for patients with MLD in the absence of an HLA matched family donor.

[De novo malignancy following renal transplantation]

The characteristics and incidence of de novo malignancy was analyzed in 376 renal transplant recipients transplanted between April 1970 and December 1992. Malignancies developed in 21 recipients of living related donor renal allografts. The total number of malignancies was 23, with 2 patients developing 2 malignancies. The mean age at the time of diagnosis was 42 years. The average interval from transplantation to the time of diagnosis was 129 months. Malignancy developed in 12 of 21 patients who survived 10 years with a functioning graft. Nine patients died of their malignancy. The risk of developing malignancy is increased following renal transplantation. Compared with sex- and age-matched Japanese control, the incidence is 6.1 times greater for male, 10.5 times greater for female, and 7.3 times greater overall. The risk was increased at all sites except the stomach. The risk rate of acquiring malignancies at 5-year intervals following transplantation was 6.5 times greater from 0 to 5 years, 10.0 times greater from 5 to 10 years, and 9.3 times greater from 10 to 15 years. These results suggest that annual medical examinations should be performed as part of the routine log-term follow-up of renal transplant recipients to detect malignancies in the early stage.

[Clinical study on reoperation for recurrent pulmonary metastasis]

Ninety seven patients with metastatic lung tumors were treated surgically in our department. Second pulmonary resections were performed in 13 patients. They consists of 9 males and 4 females, their age ranged from 12 to 75 years old (average 54.4 years old). Tumors originate from sarcoma in 5 cases, laryngeal cancer, colorectal cancer, renal cell cancer in 2 cases respectively, oral cavity cancer and transitional cell cancer in 1 case respectively. No second pulmonary resection was performed in patients with metastatic lung tumors originating from lung cancer or breast cancer, because they metastatize not only lung but also general organs. No second pulmonary resection was required in patients with testicular tumor and choriocarcinoma, because chemotherapy take good effect on them.